Additive Model of Parsonnet et al for Predicting the Risk of Mortality Within 30 Days of Cardiac Surgery

Description

Parsonnet et al developed a model to predict operative mortality for adults having surgery for acquired adult heart disease. The model uses risk factors identified by multivariate analysis that were selected to be readily available in any hospital and objective. It was developed at the Beth Israel Medical Center in Newark, New Jersey, and tested at two other medical centers.

Risk Factor	Finding	Assigned Weight
gender	male	0
	female	1
body weight	morbid obesity (>= 1.5 times ideal weight)	3
diabetes mellitus	noninsulin and insulin dependent	3
blood pressure	hypertension, with systolic blood pressure > 140 mm Hg	3
left ventricular ejection fraction	good (>= 50%)	0
	fair (30 - 49%)	2
	poor (< 30%)	4
age in years	< 70	0
	70 - 74	7
	75 - 79	12
	>= 80	20
reoperation	first	5
	second	10
preoperative intra-aortic balloon pump		2
left ventricular aneurysm		5
urgency of operation	emergency surgery following PTCA or catheterization complication	10
dialysis dependency	peritoneal dialysis	10
	hemodialysis	10
catastrophic states	acute structural defect, cardiogenic shock, acute renal failure, other	10 - 50
rare circumstances impacting cardiac surgery	paraplegia, pacemaker dependency, congenital heart disease in an adult, severe asthma, other	2 - 10
mitral valve surgery	pulmonary artery pressure < 60 mm Hg	5
	pulmonary artery pressure >= 60 mm Hg	8
aortic valve surgery	pressure gradient <= 120 mm Hg	5
	pressure gradient > 120 mm Hg	7
CABG done at the time of valve surgery		2

after Table 2, page I5, Parsonnet (1989)

additive score =

= SUM(points for conditions present)

Interpretation:

• minimum score: 0

• maximum score: 148

Additive Score	Risk Group	Estimated Mortality Rate Within 30 Days of Surgery
0 - 4	good	1%
5 - 9	fair	5%
10 - 14	poor	9%
15 - 19	high mortality	17%
>= 20	very high mortality	31%

after Figure 2, page I5, Parsonnet (1989)

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ICD-10